Hypertension, Uncontrolled With Cardiomyopathy

1.5 billion worldwide in 2014

70 million people in USA; approximately 1:3 people

USA highest prevalence: African American

Male = female

Increased risk of MI and stroke

Increased risk of CHF, ventricular hypertrophy, coronary artery disease, and atrial fibrillation

Increased risk of cerebral hypoperfusion due to right shift of the cerebral blood flow autoregulation curve

Increased risk of renal failure

Increased blood loss

Prolonged hospitalizations

Eighth Joint National Commission Hypertension Guidelines:

• BP goal <150/90 mm Hg—anyone >60 y who does not have DM or CKD.

• BP goal <140/90 mm Hg—anyone <60 y without major comorbidities and in pts >60 y with DM, CKD, or both.

• Possibility of masked hypovolemia.

• Silent myocardial ischemia may occur from supply-demand mismatches, even in absence of CAD.

• May be forerunner of renal failure and/or stroke.

• CHF may be presenting sign.

• May develop LVH ± strain pattern on ECG.

• May require >6 wk of treatment for regression of LVH.

Idiopathic with genetic predisposition (>90%) and with up to 50% of global population

Secondary hypertension due to thyroid, renal, and adrenal abnormalities

Substance abuse (alcohol, cocaine, amphetamines)

Valvular heart pathology (e.g., aortic insufficiency)

High peripheral resistance is accelerated with time